Legal LOP Letter

LETTER OF PROTECTION

This Letter of Protection is made and entered into as of by and between Patient Name: (hereinafter "Patient") and Medical Provider Name: (hereinafter "Provider"). Attorney Name: represents Patient in the matter identified as Claim Reference: .

RECITALS

WHEREAS, Patient has sustained injuries and has retained Attorney to pursue recovery for damages arising from the injury described above; and

WHEREAS, Provider has rendered or will render medical services, diagnostic testing, and related treatment to Patient and has requested assurance of payment for such services; and

WHEREAS, Attorney has agreed to use reasonable efforts to obtain recovery for Patient and to disburse funds from any recovery to Provider on the terms set forth herein.

NOW, THEREFORE

In consideration of the mutual promises contained herein and other good and valuable consideration, the parties agree as follows:

1. DEFINITIONS

For purposes of this Letter: "Recovery" means any and all settlements, judgments, awards, or other proceeds obtained by or on behalf of Patient in connection with the claim identified above, whether by litigation, arbitration, negotiation, or otherwise.

2. SCOPE OF PROTECTION

Provider agrees to provide or to continue providing medical services to Patient and to refrain from instituting collection actions against Patient for charges arising out of the treatment covered by this Letter during the pendency of Attorney's prosecution of Patient's claim, provided that Attorney continues to pursue the claim with reasonable diligence.

3. PROMISE TO PAY

Attorney hereby agrees to hold in trust any funds recovered on behalf of Patient and to disburse from such funds, after payment of reasonable attorneys' fees and litigation costs, sufficient proceeds to satisfy Provider's outstanding balance as shown on Provider's itemized statement, subject to any negotiated reduction approved in writing by Provider.

4. BILLING, STATEMENTS, AND ADJUSTMENTS

Provider shall promptly furnish Attorney and Patient with an itemized statement of all services, dates of service, and amounts claimed. Provider agrees that any adjustments or write-offs customarily applied to third-party payors shall be applied to the billed amounts where appropriate and that Provider will cooperate in good faith to document the basis for any requested reductions.

5. LIEN; SUBROGATION

Provider may, at Provider's option and consistent with applicable law, record and enforce a medical lien or claim against Recovery to secure payment of Provider's charges. Provider's exercise of any lien or similar remedy shall be limited to recovery proceeds and shall not permit personal liability against Patient for amounts covered by this Letter except as provided in Section 7 below.

6. COOPERATION

Patient and Attorney shall provide Provider with copies of pleadings, settlement statements, and other documents reasonably necessary to enforce Provider's right to payment from Recovery. Provider shall cooperate in the resolution of liens and shall provide supporting documentation upon reasonable request.

7. PATIENT LIABILITY

Except for Provider's right to pursue Recovery as provided herein, Patient shall not be required to make payments for covered services until such time as Recovery is obtained. Notwithstanding the foregoing, this Letter does not extinguish Patient's obligation for services in the event that Recovery is not obtained due to Patient's fraud, misrepresentation, abandonment of Attorney, or intentional acts that preclude recovery; in such events Provider may seek collection from Patient consistent with applicable law.

8. ALLOCATION OF RECOVERY

Attorney shall, upon obtaining Recovery, give Provider written notice and provide an accounting and copies of any settlement agreements or court orders. Provider shall be paid from the Recovery after deduction of reasonable attorneys' fees and documented costs; the parties acknowledge that allocation disputes as to the portion of Recovery attributable to medical damages will be resolved in good faith among Provider, Patient, and Attorney prior to disbursement.

9. REPRESENTATIONS AND WARRANTIES

Each party represents and warrants that it has the authority to enter into this Letter, that the information provided to the other parties is true and correct to the best of its knowledge, and that execution of this Letter will not violate any other agreement by which the party is bound.

10. TERMINATION

This Letter shall terminate upon final disbursement of Recovery and payment to Provider in accordance with this Letter, or by written agreement of the parties. Termination shall not affect Provider's right to be paid from any Recovery obtained prior to termination.

11. NOTICES

Any notice required or permitted by this Letter shall be in writing and delivered by hand, certified mail (return receipt requested), or nationally recognized overnight courier to the addresses set forth below or such other address as a party may designate by written notice.

12. AMENDMENT; WAIVER

No amendment, modification, or waiver of any provision of this Letter will be effective unless in writing and executed by all parties. No failure or delay by any party in exercising any right will operate as a waiver of that right.

13. GOVERNING LAW

This Letter shall be governed by and construed in accordance with the laws of the state of without regard to principles of conflicts of law.

14. ENTIRE AGREEMENT

This Letter constitutes the entire agreement among the parties with respect to the subject matter hereof and supersedes all prior and contemporaneous agreements and understandings, whether written or oral.

15. SEVERABILITY

If any provision of this Letter is held to be invalid, illegal, or unenforceable, the remaining provisions shall continue in full force and effect to the maximum extent permitted by law.

The parties have executed this Letter of Protection as of the date first written above.

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